Incontinence

Incontinence is the unintentional passage of urine, stool, or gas through theanus or urinary tract. For some people, incontinence is a relatively minor problem, as when it is limited to a slight occasional soiling of underwear, but for others it involves considerable physical and/or emotional distress.

Approximately 13 million Americans suffer from urinary incontinence. Women are affected by the disorder more frequently than are men; one in 10 women under age 65 suffer from urinary incontinence. Older Americans, too, are more prone to the condition. Twenty percent of Americans over age 65 are incontinent.

Fecal incontinence, also called bowel incontinence, can occur at any age, butis most common among people over the age of 65.

Incontinence sufferers often hesitate to ask their doctors for help because they are embarrassed or ashamed.

Incontinence can result from a wide variety of medical conditions, includingnervous system problems, Parkinson's disease, and bladder dysfunction. Childbirth can also lead to incontinence. It can weaken the pelvic muscles and cause the bladder to lose some support from surrounding muscles, resulting in stress incontinence. Vaginal-delivery childbirth can resultin damage to the anal sphincter, the ring of muscle that closes the anus. Childbirth-related incontinence is usually restricted to gas, but for some women involves the passing of liquid or solid stools.

Surgery can also result in incontinence. For example, hysterectomy orother gynecological surgery can damage or weaken the pelvic muscles that control the flow of urine. The removal of hemorrhoids by surgery or othertechniques can also cause anal damage and fecal incontinence, as can more complex operations affecting the anus and surrounding areas. Anal and rectal infections as well Crohn's disease can lead to incontinence by damaging the muscles that control defecation. For some people, incontinence becomes a problemwhen the anal muscles begin to weaken in midlife or old age.

Dementia, mental retardation, strokes, brain tumors, and other conditions that affect the nervous system can cause incontinence by interfering withmuscle function or the normal sensations that trigger bladder and bowel control. One study of multiple sclerosis patients discovered that about half were incontinent. Nerve damage caused by long-lasting diabetes mellitus (diabetic neuropathy) is another condition that can give rise to incontinence.

Medical assessments in cases of incontinence typically involve asking questions about the patient's past and current health. For women who have given birth, a detailed obstetric history is also necessary. A physical examination is typically performed, along with specific diagnostic testing to determine the cause of the incontinence. Diagnostic testing may include x rays, ultrasound, urine tests, and a physical examination of the pelvis and perianal area.

Incontinence arising from an underlying condition such as diabetic neuropathycan sometimes be helped by treating the underlying condition. When that doesnot work, or no underlying condition can be discovered, medication may be used, such as loperamide (Imodium), anticholinergics (i.e., propantheline, or Pro-Banthine) and antispasmodics (i.e., oxybutynin, or Ditropan). Otherover-the-counter medications such as pseudoephedrine (i.e., Actifed,Benadryl, Dimetapp) and phenylpropanolamine (i.e., Dexatrim, Acutrim) may beprescribed to tighten the urethral sphincter.

In addition, the doctor may have the incontinent patient establish regularlytoileting habits, either by creating a schedule or by using a suppository orenema to stimulate defecation at the same time every day or every other day.

Dietary changes and exercises done at home to strengthen the muscles may alsohelp.

Incontinence usually responds well to professional medical treatment, even among elderly and institutionalized patients. If complete control cannot be restored, the impact of incontinence on everyday life can still be lessened considerably in most cases. When incontinence remains a problem despite medical treatment, disposable underwear and other commercial incontinence products areavailable to make life easier. Doctors and nurses can offer advice on copingwith incontinence, and people should never be embarrassed about seeking their assistance. Counseling and information are also available from support groups.

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